But by popular perception, the act kicked in last Oct. 1, when enrollment for individual insurance plans via the federal and state exchanges opened nationwide. For all intents and purposes, then, Wednesday was Obamcare's first birthday. How's it doing?
The inescapable answer is: very well, thank you. This will disappoint the legions of politicians and pundits, chiefly Republicans and conservatives, who became heavily invested in the act's failure--so heavily that where they couldn't point to tangible evidence of failure, which was most of the time, they resorted to distortion, outright fabrication and obstructionist legal strategies. Yes, the federal enrollment website, HealthCare.Gov, was a botch at the beginning. It has since been fixed, and federal enrollments ended up outpacing even the original, pre-botch, expectations.
We've devoted reams of copy to exploding the cherished myths of the Obamacare meltdown. Suffice to say that the failure of Obamacare has turned out to be a bad investment indeed. Several Republican governors, having squeezed all the ideological mileage they could from undermining the act, leaving their own most vulnerable citizens more impoverished and sick, recently have thrown in the towel, moving to expand
It's proper now to examine the tangible evidence that Obamacare has improved the lives of millions of Americans, in exactly the way its drafters expected. See the accompanying graphics for more.
1. The ACA has sharply reduced the number of uninsured Americans. Gallup reported in July that the uninsured rate for adult Americans of 13.4% was the lowest it had recorded since it began measuring the rate in 2008. "This downward trend in the uninsured rate coincided with the health insurance marketplace exchanges opening in October 2013, and accelerated as the March 31 deadline to purchase health insurance coverage approached -- and passed -- for most uninsured Americans." The trend continued through the April 15 extended deadline for 2014 enrollment.
Gallup's findings are supported by results from the Commonwealth Fund, Rand Corp. and the Urban Institute. The last of these found, notably, that the rate dropped especially sharply among states that have expanded Medicaid under the ACA--hardly a surprise, since that provision, shunned by many Republican state governments, specifically addressed lack of insurance among the poorest Americans.
2. The ACA has materially cut hospital outlays for uncompensated care. The Department of Health and Human Services says these costs will be $5.7 billion less in 2014, a 16% drop, than they would have been without the law. The agency attributes the change to an estimated decrease of 10.3 million uninsured persons, and an increase of 8 million in Medicaid rolls. Its estimate of costs is based partially on reports from hospital companies, which have found huge reductions in the volume of uninsured admissions; at Tenet Healthcare, a nationwide hospital chain, uninsured admissions dropped 33% in the first quarter of 2014 compared to a year earlier.
Is the ACA perfect? Of course not, but that's hardly the proper standard to apply to a law that dramatically reshapes the healthcare landscape. In its one-year report card, the Commonwealth Fund gave a "needs improvement" grade to the online exchange enrollment experience, based on its finding that 62% of enrollees were still rating the websites fair or poor, even as late as June.
But the fund gave the act "good to excellent" grades for its having enrolled some 15.3 million people in marketplace plans or Medicaid by mid-August and for its reduction in the uninsured rate.
On the question of whether Americans were using their new insurance to get treatment, the Commonwealth Fund gave the ACA "extra credit": according to a survey the fund conducted in April, May and June, 60% of people who had new coverage had already used it to obtain healthcare. "People with new coverage appear to be getting the doctors they want and getting appointments with wait times consistent with U.S. averages."